Download PDF
Indian Journal of Neurosurgery 2013; 02(03): 240-247
DOI: 10.4103/2277-9167.124229
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Subarachnoid hemorrhage in pituitary tumor

Ashis Patnaik
,
Ashok Kumar Mahapatra
1   Neurosurgery, AIIMS, Bhubaneswar, Odisha, India
› Author Affiliations
Subject Editor:
Further Information

Publication History

Publication Date:
18 January 2017 (online)

  PDF Download  Permissions and Reprints

Abstract

Subarachnoid hemorrhage (SAH) is the bleeding into the subarachnoid space containing cerebrospinal fluid. The most common cause of SAH is trauma. Rupture of aneurysms, vascular anomalies, tumor bleeds and hypertension are other important etiologies. SAH in the setting of pituitary tumor can result from various causes. It can be due to intrinsic tumor related pathology, injury to surrounding the vessel during the operative procedure or due to an associated aneurysm. We discuss the pathological mechanisms and review relevant literature related to this interesting phenomenon. Early and accurate diagnosis of the cause of the SAH in pituitary tumors is important, as this influences the management.

Key words

Apoplexy - pituitary tumors - subarachnoid haemorrhage
 

  • References

  • 1 Kovacs K, Scheithauer BW, Horvath E, Lloyd RV. The World Health Organization classification of adenohypophysial neoplasms. A proposed five-tier scheme. Cancer 1996; 78: 502-510
    PubMedGoogle Scholar
  • 2 Tomita H, Urui S, Kokunai T, Tamaki N. A case of metastatic tumor of the pituitary gland presenting as a subarachnoid hemorrhage. No Shinkei Geka 2000; 28: 1117-1120
    PubMedGoogle Scholar
  • 3 Jenkins JS. Pituitary Tumours. London: Butterworths; 1973. p 59-60
    Google Scholar
  • 4 Lang J. Duramater of the pituitary region. In: Wilson RR, Winstanley DP. editors Clinical Anatomy of the Head. New York: Berlin, Heidelberg: Springer Verlag; 1983. p 138-141
    Google Scholar
  • 5 Kuroyanagi T, Kobayashi S, Takemae T, Kobayashi S. Subarachnoid hemorrhage, midbrain hemorrhage and thalamic infarction following transsphenoidal removal of a pituitary adenoma. A case report. Neurosurg Rev 1994; 17: 161-165
    CrossrefPubMedGoogle Scholar
  • 6 Housepian EM, Pool JL. A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914-1956. J Neuropathol Exp Neurol 1958; 17: 409-423
    CrossrefPubMedGoogle Scholar
  • 7 Okada H, Kodama N, Mineura K, Sakamoto T, Suzuki J. A ruptured aneurysm associated with pituitary tumor (author’s transl). No Shinkei Geka 1980; 8: 379-381
    PubMedGoogle Scholar
  • 8 Mohanty S, Tandon PN, Banerji AK, Prakash B. Haemorrhage into pituitary adenomas. J Neurol Neurosurg Psychiatry 1977; 40: 987-991
    CrossrefPubMedGoogle Scholar
  • 9 Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: Its incidence and clinical significance. J Neurosurg 1981; 55: 187-193
    CrossrefPubMedGoogle Scholar
  • 10 Bao YJ, Li XG, Jing ZT, Ou SW, Wu AH, Wang YJ. Pituitary apoplexy complicated with subarachnoid hemorrhage caused by incidentaloma following a head injury: Case report. Chin Med J (Engl) 2007; 120: 2341-2343
    PubMedGoogle Scholar
  • 11 Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol 1982; 18: 181-189
    CrossrefPubMedGoogle Scholar
  • 12 Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA. Classical pituitary apoplexy: Clinical features, management and outcome. Clin Endocrinol (Oxf) 1999; 51: 181-188
    CrossrefPubMedGoogle Scholar
  • 13 MacFadzean RM, Teasdale GM. Pituitary apoplexy. In: Landolt AM, Vance ML, Reilly PL. editors Pituitary Adenomas. New York: Churchill Livingstone; 1996. p 485-501
    Google Scholar
  • 14 Nourizadeh AR, Pitts FW. Hemorrhage into pituitary adenoma during anticoagulant therapy. JAMA 1965; 193: 623-625
    CrossrefPubMedGoogle Scholar
  • 15 Itoyama Y, Goto S, Miura M, Kuratsu J, Ushio Y, Matsumoto T. Intracranial arterial vasospasm associated with pituitary apoplexy after head trauma - Case report. Neurol Med Chir (Tokyo) 1990; 30: 350-353
    CrossrefPubMedGoogle Scholar
  • 16 Uihlein A, Balfour WM, Donovan PF. Acute hemorrhage into pituitary adenomas. J Neurosurg 1957; 14: 140-151
    CrossrefPubMedGoogle Scholar
  • 17 Glass B, Abbott KH. Subarachnoid hemorrhage consequent to intracranial tumors; review of literature and report of seven cases. AMA Arch Neurol Psychiatry 1955; 73: 369-379
    CrossrefPubMedGoogle Scholar
  • 18 Balarini Lima GA, Machado Ede O, Dos Santos Silva CM, Filho PN, Gadelha MR. Pituitary apoplexy during treatment of cystic macroprolactinomas with cabergoline. Pituitary 2008; 11: 287-292
    CrossrefPubMedGoogle Scholar
  • 19 Kirshbaum JD, Chapman BM. Subarachnoid hemorrhage secondary to a tumor of the hypophysis with acromegaly. Ann Intern Med 1948; 29: 536-540
    CrossrefPubMedGoogle Scholar
  • 20 Beard K, Macdougall IC, Behan WM. Acromegaly presenting as subarachnoid haemorrhage in a 76 year old woman. Postgrad Med J 1985; 61: 615-617
    CrossrefPubMedGoogle Scholar
  • 21 Mohanty S, Thacker AK, Katiyar BC, Misra S, Rao CJ, Rao SN. Recurrent subarachnoid haemorrhage in pituitary adenoma. J Assoc Physicians India 1979; 27: 539-541
    PubMedGoogle Scholar
  • 22 Nakahara K, Oka H, Utsuki S, lida H, Kurita M, Mochizuki T. et al Pituitary apoplexy manifesting as diffuse subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 2006; 46: 594-597
    CrossrefPubMedGoogle Scholar
  • 23 Satyarthee GD, Mahapatra AK. Pituitary apoplexy in a child presenting with massive subarachnoid and intraventricular hemorrhage. J Clin Neurosci 2005; 12: 94-96
    CrossrefPubMedGoogle Scholar
  • 24 Gazioglu N, Kadioglu P, Ocal E, Erman H, Akar Z, Oz B. An unusual presentation of Nelson’s syndrome with apoplexy and subarachnoid hemorrhage. Pituitary 2002; 5: 267-274
    CrossrefPubMedGoogle Scholar
  • 25 Kubota T, Fujii H, Ikeda K, Ito H, Yamamoto S, Nakanishi I. A case of intraventricular craniopharyngioma with subarachnoid hemorrhage (author’s transl). No Shinkei Geka 1980; 8: 495-501
    PubMedGoogle Scholar
  • 26 Zheng F, Li W, Li H, Dong X. Pituitary apoplexy manifested as subarachnoid hemorrhage accompanied by primary hypothyroidism: A case report. Endocrinologist 2010; 20: 69-71
    CrossrefPubMedGoogle Scholar
  • 27 Wohaibi MA, Russell NA, Ferayan AA, Awada A, Jumah MA, Omojola M. Pituitary apoplexy presenting as massive subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 2000; 69: 700-701
    CrossrefPubMedGoogle Scholar
  • 28 Yamada SM, Aoki M, Nakane M, Nakayama H. A case of subarachnoid hemorrhage with pituitary apoplexy caused by idiopathic hypertrophic pachymeningitis. Neurol Sci 2011; 32: 455-459
    CrossrefPubMedGoogle Scholar
  • 29 Sanno N, Ishii Y, Sugiyama M, Takagi R, Node Y, Teramoto A. Subarachnoid haemorrhage and vasospasm due to pituitary apoplexy after pituitary function tests. Acta Neurochir (Wien) 1999; 141: 1009-1010
    CrossrefPubMedGoogle Scholar
  • 30 Jakubowski J, Kendall B. Coincidental aneurysms with tumours of pituitary origin. J Neurol Neurosurg Psychiatry 1978; 41: 972-979
    CrossrefPubMedGoogle Scholar
  • 31 Wakai S, Fukushima T, Furihata T, Sano K. Association of cerebral aneurysm with pituitary adenoma. Surg Neurol 1979; 12: 503-507
    PubMedGoogle Scholar
  • 32 Tsuchida T, Tanaka R, Yokoyama M, Sato H. Rupture of anterior communicating artery aneurysm during transsphenoidal surgery for pituitary adenoma. Surg Neurol 1983; 20: 67-70
    CrossrefPubMedGoogle Scholar
  • 33 Jordan RM, Kerber CW. Rupture of a parasellar aneurysm with a coexisting pituitary tumor. South Med J 1978; 71: 741-742
    CrossrefPubMedGoogle Scholar
  • 34 Jaunsolo MA, Aguirre M, Bellido D, Castro S, Ruiz-Valdepenas MP, Hawkins FG. Association of acromegaly and a cerebral arterial aneurysm disclosed by a subarachnoid hemorrhage. Neurochirurgie 1986; 32: 266-268
    PubMedGoogle Scholar
  • 35 Liu H, Yang Z. Clinical analysis of 6 cases with subarachnoid hemorrhage during transsphenoidal surgery for lesions of sellar region. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2002; 16: 533-534
    PubMedGoogle Scholar
  • 36 Laidlaw JD, Tress B, Gonzales MF, Wray AC, Ng WH, O’Brien JM. Coexistence of aneurysmal subarachnoid haemorrhage and pituitary apoplexy: Case report and review of the literature. J Clin Neurosci 2003; 10: 478-482
    CrossrefPubMedGoogle Scholar
  • 37 Goyal N, Basheer N, Suri A, Mahapatra AK. Subarachnoid hemorrhage after transsphenoidal surgery for pituitary adenoma: A case report and review of literature. Neurol India 2012; 60: 337-338
    CrossrefPubMedGoogle Scholar
  • 38 Matsuno A, Yoshida S, Basugi N, Itoh S, Tanaka J. Severe subarachnoid hemorrhage during transsphenoidal surgery for pituitary adenoma. Surg Neurol 1993; 39: 276-278
    CrossrefPubMedGoogle Scholar
  • 39 Ito Y, Takano S, Muroi A, Matsumura A. Massive subarachnoid hemorrhage and intraventricular hemorrhage after transsphenoidal surgery of pituitary adenoma: A case report. No Shinkei Geka 2009; 37: 887-892
    PubMedGoogle Scholar
  • 40 Nishioka H, Ito H, Haraoka J. Cerebral vasospasm following transsphenoidal removal of a pituitary adenoma. Br J Neurosurg 2001; 15: 44-47
    CrossrefPubMedGoogle Scholar
  • 41 Goel A, Deogaonkar M, Desai K. Fatal postoperative ‘pituitary apoplexy’: Its cause and management. Br J Neurosurg 1995; 9: 37-40
    CrossrefPubMedGoogle Scholar
  • 42 Ahmad FU, Pandey P, Mahapatra AK. Post operative ‘pituitary apoplexy’ in giant pituitary adenomas: A series of cases. Neurol India 2005; 53: 326-328
    CrossrefPubMedGoogle Scholar
  • 43 Patel SK, Christiano LD, Eloy JA, Liu JK. Delayed postoperative pituitary apoplexy after endoscopic transsphenoidal resection of a giant pituitary macroadenoma. J Clin Neurosci 2012; 19: 1296-1298
    CrossrefPubMedGoogle Scholar
  • 44 Kurwale NS, Ahmad F, Suri A, Kale SS, Sharma BS, Mahapatra AK. et al Post operative pituitary apoplexy: Preoperative considerations toward preventing nightmare. Br J Neurosurg 2012; 26: 59-63
    CrossrefPubMedGoogle Scholar
  • 45 Majchrzak H, Wencel T, Dragan T, Bialas J. Acute hemorrhage into pituitary adenoma with SAH and anterior cerebral artery occlusion. Case report. J Neurosurg 1983; 58: 771-773
    PubMedGoogle Scholar
  • 46 Kim YG, Lee JS, Park MS, Ha HG. Pituitary apoplexy mimicking aneurysmal rupture of anterior communicating artery. J Korean Neurosurg 2003; 34: 249-251
    PubMedGoogle Scholar
  • 47 Rinkel GJ, van Gijn J, Wijdicks EF. Subarachnoid hemorrhage without detectable aneurysm. A review of the causes. Stroke 1993; 24: 1403-1409
    PubMedGoogle Scholar
  • 48 Semple PL, Webb MK, de Villiers JC, Laws Jr ER. Pituitary apoplexy. Neurosurgery 2005; 56: 65-72
    CrossrefPubMedGoogle Scholar
  • 49 Maccagnan P, Macedo CL, Kayath MJ, Nogueira RG, Abucham J. Conservative management of pituitary apoplexy: A prospective study. J Clin Endocrinol Metab 1995; 80: 2190-2197
    PubMedGoogle Scholar